Top 5 Fridays! 5 Myths of Core Stability | Modern Manual Therapy Blog

Top 5 Fridays! 5 Myths of Core Stability


Ever since the original Hodges TrA research, the "core" has been a core of much of rehab and fitness programs. I've even had world record power lifters been told they need to strengthen their core. Dalton Urrutia, @physicaltherapyresearch on instagram put together a great series on the Myths of Core Stability. Please share with everyone who is so core focused and promoting weakness and Thought Viruses! #stopthoughtviruses.

It's 5+some bonus slides for this Top 5 Fridays!
🔬📚 (0/6) MYTH OF CORE STABILITY SERIES: 💡 Core stability (CS) is widely accepted in training for the prevention and treatment of injury and various musculoskeletal conditions, especially low back pain. . 💡 CS came about is the late 1990s and was based on studies demonstrating changes in onset timing of the trunk muscles in back injury and chronic lower back pain (CLBP) patients (Hodges and Richardson, 1996 & 1998) 💡 Trunk control research has contributed to the understanding of neuromuscular reorganization in back pain and injury. . 💡 CS studies have confirmed that motor control of the trunk muscles of patients who suffer from back injury and pain are altered. 💡 However, these findings combined with general beliefs about the importance of abdominal muscles for a strong back, and influences from Pilates, have promoted several assumptions prevalent in CS training. 💡 Lederman (2010), re-examines core stability/spinal stabilization approaches and their efficacy within the wider knowledge of motor control, prevention of injury and rehabilitation. ✅✅ This week’s Myth of Core Stability Series will reviews several assumptions prevalent in ‘Core Stability’ training: 1️⃣Assumptions about stability and the role of TrA and other core muscle 2️⃣The timing issue 3️⃣The strength issue 4️⃣The single/core muscle activation problem 5️⃣CS and training in relation to motor learning and training issues 6️⃣CS in prevention of injury and therapeutic value, specifically Low Back Pain ↗️↗️ Don’t miss anything! - Make sure and turn post notifications on 💭💭 Post your thoughts, comments, and questions below 📚📚📚 SOURCE: Lederman 2010. The Myth of Core Stability. Jrn Body & Mvmt Thera. 14, pp. 84e98.
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🔬📚 (1/6) MYTH OF CORE STABILITY SERIES: 💡 Myths of Core Stability Series: 1. Assumptions about stability and the role of Transverse Abdominis (TrA) and other core muscles. 💡 The TrA receives most of the CS focus and is widely believed to be the main anterior component of trunk stabilization. . 💡 However, many different muscles of the trunk contribute to stability and their action may change according to varying tasks. 💭💭 How essential is TrA for spinal stabilization? . 💭 This can be assessed in situations where the muscle is damaged or put under abnormal mechanical stress, for example in: Pregnancy Post-partum Obesity 💭 The abdomen distension can disrupt the normal mechanics and control of the trunk muscles, including TrA. . 💭 According to the CS model this should result in an increased incidence of back pain. . 💭 However, epidemiological studies demonstrate Pregnancy, Post-partum, and obesity are only weakly associated with lower back pain (LeboeufYde, 2000; Fast et al 1990) . 💥💥 What about abdominal muscles damaged by surgery? Would such damage affect spinal stability or contribute to back pain? . 💥 In breast reconstruction after mastectomy, one side of the rectus abdominis is used for reconstruction of the breast. . 💥 Leaving only one side of rectus abdominis and weakness of the abdominal muscles. 💥 Such alteration in trunk biomechanics would also be expected to result in profound motor control changes, yet there is no relationship to back pain or impairment to functional/movement activities, measured up to several years after the operation (Mizgala et al., 1994; Simon et al., 2004). . 💥 No study to date has demonstrated that LBP is due to spinal instability. Despite a decade of research in this area it remains a theoretical model. . ↗️↗️
Make sure and turn post notifications! Keep posted for: 2️⃣The timing issue 3️⃣The strength issue 4️⃣The single/core muscle activation problem 5️⃣CS and training in relation to motor learning and training issues 6️⃣CS in prevention of injury and therapeutic value, specifically Low Back Pain 📚📚 SOURCE: Lederman 2010. The Myth of Core Stability. Jrn Body & Mvmt Thera. 14, pp. 84e98.
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🔬📚 (2/6) MYTH OF CORE STABILITY SERIES: 💡 Myths of Core Stability Series: 2. The Timing Issue . 💡 Research shows with rapid arm/leg movement, the TrA in CLBP patients had delayed onset timing 💡 Consequently it was assumed TrA is dominant in controlling spinal stability (Hodges et al., 2003). . 💡 Therefore any weakness or decreased control of TrA means trouble for the back. . 💡 This is a faulty assumption: 1. TrA is one of many trunk muscles anticipating movement. Recent suggestions state earlier activity of TrA may compensate for its long elastic anterior fasciae (Macdonald et al., 2006). . 2. Delayed onset timing may be an advantageous protection strategy rather than a dysfunctional activation pattern. . . 3. During the fast movement of the outstretched arm the subject performed a reflexive pain evasion action that involved delayed activation of TrA, an action unrelated to stabilization (Moseley et al., 2004) . 4. Onset time differences between asymptomatic and CLBP were 1/50 sec. (Radebold et al., 2000). 💭 This is well beyond the patient’s conscious control and the clinical capabilities of the therapist to test or alter. . . 5. Strength training for TrA is believed to normalize timing dysfunction. . 💭 This is unlikely to reset timing due to transfer and specificity training principles. 💭 It is like aspiring to play the piano faster by exercising with finger weights. 💭 To control onset timing switch movements between synergists at a fast rate, and hope that the system will reset itself (Lederman, 2005). . . 6. To overcome the timing problem, continuously contracting TrA is taught . 💭 This is an abnormal pattern of control to overcome a natural protective strategy (SEE PHOTO) 💭 7. No study to date demonstrates core stability exercise resets onset timing in CLBP patients ✅✅ Make sure and turn post notifications! Keep posted for: 3️⃣The strength issue 4️⃣The single/core muscle activation problem 5️⃣CS and training in relation to motor learning and training issues 6️⃣CS in prevention of injury and therapeutic value, specifically Low Back Pain 📚📚 SOURCE: Lederman 2010. The Myth of Core Stability. Jrn Body & Mvmt Thera. 14, pp. 84e98.
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🔬📚 (3/6) MYTH OF CORE STABILITY SERIES: 💡 Myths of Core Stability Series: 3. The Strength Issue . 💡 There is confusion about trunk strength’s relation to back pain and injury prevention. . 💡 Trunk muscle control including force losses can be consequential of back pain/injury. . 💡 However, several assumptions are often made: 1. Loss of core muscle strength could lead to back injury. 2. Increasing core strength can alleviate back pain. 💭 To what force level do the trunk muscles need to co-contract in order to stabilize the spine?…Not very much [SWIPE LEFT] 💭 During standing trunk muscles, deep spinal erectors, psoas and quadratus lumborum are nearly silent! . 💭 Maximal voluntary contraction (MVC) during walking: Rectus abdominis: 2% External oblique: 5% . 💭 During standing ‘‘active’’ stabilization is achieved by less than 1% MVC of trunk flexors and extensors. 💭 During bending and lifting a weight of about 15 kg co-contraction increases by only 1.5% MVC. 💭 Why are strength exercises prescribed with such low required levels of co-contraction for functional movement? 💭 For most, conscious co-contraction is: . * More than is required for stabilization . . * Could increase compression of the lumbar spine * Reduce economy of movement . 💥 Is there a relationship between weak abdominals (e.g. TrA) and back pain? . 💥 There is no evidence reduced trunk muscle strength or endurance will predispose individuals to LBP . 💥 There are inconclusive finding regarding loss of trunk muscle strength and atrophy in response to CLBP 💥 CS exercises do not provide the overtraining challenge expected for strength or endurance gains 💥 70% MVC is needed to promote strength gains in abdominal muscle . 💥 Improvement in back pain seems to be due to: Changes in lumbar muscles neural activation Psychological changes (motivation or pain tolerance) ✅✅
Make sure and turn post notifications! Keep posted for: 4️⃣The single/core muscle activation problem 5️⃣CS and training in relation to motor learning and training issues 6️⃣CS in prevention of injury and therapeutic value, specifically Low Back Pain 📚📚 SOURCE: Lederman 2010. The Myth of Core Stability. Jrn Body & Mvmt Th
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📚🔬 (4/6) MYTH OF CORE STABILITY SERIES: 💡 Myths of Core Stability Series: 4. The single/core muscle activation problem . 💡 One principle of CS is to isolate TrA from the rest of the abdominal muscles 💡 It is doubtful a ‘‘core’’ group of trunk muscles can be recruited independently (McGill et al., 2003; Kavcic et al., 2004). . 💡 To specifically activate the core muscles during functional movement natural patterns of trunk muscle activation would have to be overridden. 💡 This would be impractical and next to impossible (Georgopoulos, 2000). . 💡 If you bring your hand to your mouth the nervous system ‘‘thinks’’ hand to mouth rather than flex the biceps, then the pectorals, etc. . 💡 Research has demonstrated, when tapping the tendons of rectus abdominis, external oblique, and internal oblique the evoked stretch reflex responses spread extensively to ipsilateral and contralateral muscles (Beith and Harrison, 2004). . 💡 This suggests sensory feedback and reflex control of the abdominal muscles is functionally related and would be difficult to separate by conscious effort. 💭💭 This simple principle in motor control poses two problems to CS training: 1. It’s doubtful following injury one group of muscles would be affected. In CLBP a complex and wide reorganization of motor control is seen in response to damage or pain. 2. There is no support from research that TrA can be singularly activated (Cholewicki et al., 2002a,b). So why focus on TrA or any other specific muscle or muscle group? . 💭💭 We can summaries that: 1️⃣ The control of the trunk (and body) is whole. No evidence exists suggesting any core muscles work independently during normal functional movement. 
2️⃣ There is no evidence individuals can effectively learn to specifically activate one muscle group independently ✅✅↗️
Make sure and turn post notifications! Keep posted for: 5️⃣CS and training in relation to motor learning and training issues 6️⃣CS in prevention of injury and therapeutic value, specifically Low Back Pain 📚📚 SOURCE: Lederman 2010. The Myth of Core Stability. Jrn Body & Mvmt Thera. 14, pp. 84e98.
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🔬📚 (5/6) MYTH OF CORE STABILITY SERIES: 💡 CS training clashes with three important principles: 1️⃣Transfer & Specificity When we train for an activity we become skilled at performing it. . 📉 Contracting anterior abdominal muscles lying supine is not guaranteed to transfer to control and physical adaptation during standing, running, bending, etc. 📉 Such control would have to be practiced during these activities [SWIPE LEFT] 📉 Anyone who is giving CS exercise to improve sports performance should re-familiarize themselves with this basic principle. . 2️⃣Internal/External Focus When learning movement it can be helpful to focus on: Their technique (internal focus) - Novice Learners The movement goal (external focus) - Skilled Learners 📈 but skilled learning ability reduces when focus is on internal processes (McNevin et al., 2000, 2003). . 📈 Tensing trunk muscles is shown to degrade postural control (Reeves et al., 2006). . 📈 What about movement rehabilitation for CLBP patients? . 📈 Complex internal focusing is the essence of CS training, but would be difficult to apply when learning simple tasks; I.e. hip hinging . 3️⃣Economy of Movement CS advice involves continuously tighten abdominal and back muscles. . 📊 This could reduce the efficiency of movement during daily and sports activities. . 📊 Our bodies are designed for optimal expenditure of energy during movement. 📊 Co-contraction is known to be an ‘‘energy waster’’ in initial motor learning situations. . 💥💥 We can conclude for the evidence: CS exercises conflict with motor learning and training principles. CS exercises are dissimilar to normal physiological movement and is ineffective when learning motor skills. 
Internal-focus approach is likely to degrade motor learning and skilled performance. 
Additional tensing of trunk muscles during daily activities or sports is likely more energetically inefficient. . ✅✅↗️
Make sure and turn post notifications! Keep posted for: 6️⃣CS in prevention of injury and therapeutic value, specifically Low Back Pain 📚📚 SOURCE: Lederman 2010. The Myth of Core Stability. Jrn Body & Mvmt Thera. 14, pp. 84e98.
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🔬📚 (6/6) MYTH OF CORE STABILITY SERIES: 💡 The CS approach is used for improving sports performance, preventing injury and treating lower back pain (Kibler et al., 2006). . 💡 However, some clinical studies don't support this: 💭💭 Helewa et al., (1999), included 402 asymptomatic subjects; . 💭 Were given back education or back education and abdominal strengthening exercise. 💭 No significant differences were found between the two groups over 1 year for LBP and LBP episodes. 💭 This study was carried out on asymptomatic subjects who were identified as having weak abdominal muscles. . 💭 Four hundred individuals with weak abdominal muscles and no back pain! . 💭 Nadler et al. (2002), examined the influence of a core-strengthening program on LBP in 257 collegiate athletes. 💭 No significant advantage was found of core strengthening to reduce LBP occurrence. . 📈📈 CS a treatment for recurrent LBP and CLBP . 📈 Initially, studies of CS exercise for the treatment of recurrent LBP look promising and significant improvements can be demonstrated when compared to other forms of therapy. 1,2,3,4,5,6,7 A: [SWIPE LEFT] 📈 Systematic reviews found stabilization exercise to be better than general practitioner care, but not from any other form of physical therapy. 8,9,10 . 📈 However, none of these studies actually showed relationships between improvement in LBP and spinal stabilization or core control. . 📈 Many of these studies did not have a control group. 📈 Meaning CS may not be any better than a placebo/sham treatment. . 📈 An interesting trend emerges when CS exercise are compared to general exercise [SWIPE LEFT]. 📈 Both exercise approaches are demonstrated to be equally effective . 📈 Suggesting improvements are due to positive effects of physical exercise vs. spinal stability. 📈 Which includes CS exercise. But patients should be informed the spine is inherently stable and CS is only as effective as any other exercise. . 💥💥 CONCLUSION: CS exercise may be better than general medical care . 💥 CS exercise is no better than other manual or physical therapy or general exercise . 📚📚 SOURCE: Lederman 2010. The Myth of Core Stability. Jrn Body & Mvmt Thera. 14, pp.
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